Nursing Education and the Black Nurse . . . An Overview

OPSOMMING In 1908 registreer Cecilia Makiwane as die eerste Swart professionele verpleegster. Op 31 December 1977 is 18 362 Swart verpleegsters by die S .A . Verpleegstersraad geregistreer. Dit is egter eers sedert die totstandkoming van die S .A . Verpleegstersraad in 1944, dat verplegingsonderwys vir Swart mense begin momentum kry. Vanaf 1940 tot 1977 vermeerder die getal opleidingskole vir Swart algem ene verpleegstudente van 17 na 71 en vir vroedvroue van 5 na 60. Daar is 6 skole vir psigiatriese verpleegstudente in 1977. Op 31 Desember 1977 is 6,3% van Swart studente wat daardie jaar vir die eerste keer met algemene en psigiatriese opleiding begin, in besit van ’n St. X kwalifikasie. Die slaagpersentasie vir die Raad se eindeksaniens handhaaf 'n stygende lyn en uitstekende resultate (74%-80% slaag) word oor die algemeen sedert 1966 behaal. Ingeskrewe verpleegsters vul die getal verplegingspraktisyns aan. Aan die einde van 1977 is daar 13 300 op die rolle van die S .A . Verpleegstersraad. Sedert 1971 word Swart studente vir die B. Cur. (I et A)-graad en die Diplomas in Verplegingsonderwys en Verplegingsadm inistrasie, aan die Universiteit van die Noorde opgelei. 81 Dip. V .O ’s, 65 Dip. V .A .’s en 15 grade is tot datum verkry. Sedert 1976 registreer groot getalle Swart studente vir verplegingskursusse by die Universiteit van Suid-Afrika. In 1978 is die getal 769, of 50% van die totaal vir hierdie kursusse. Die eerste Hon. B.A. (Cur.-graad is vanjaar (1978) deur hierdie Universiteit aan ’n Swart verpleegster toegeken.

I N 1907, C ecilia M akiw ane passed the final exam ina tion for general nurses o f the Cape Colonial Medical Council, and on 7 January 1908 becam e the first Black registered professional nurse in South A frica (1:269).On 31 December 1977 there were 18 362 Black nurses on the regis ters of the South African Nursing C ouncil3.
At the time when a new Health Act (63/1977) and a new N ursing A ct (5 0 /1 9 7 8 ) have been p ro m u lg a te d , and " Curationis" makes its début, it is well to look at the high lights of the developm ent o f nursing education for Blacks during the past 70 years.

TH E PERIOD FROM ± 1850 TO 1944
The history of nursing education for Blacks is an integral part o f our nursing history as a whole, and of the develop ment of our health services generally.The first organised health service for Blacks was started in the Graham stown area in 1850 by missionaries (1:77) and the first civilian hospital for Black people (also for indigent W hites) was established at King W illiams Town in 1856 (1:125-7).
Briefly, some important events in the early history o f our nursing education, which also have a bearing on our subject, are: -1810: 1 -y e a r c o u rs e , fo r m id w iv e s (W h ite and n o n -W h ite * ) sta rte d at th e C a p e by D r. J .H  In 1927 the first Black nurse, Beatrice M simeng was registered dually as nurse and midwife (1:272) and in 1931 Ram asolo Paul Tsae became the first male registered nurse (1:273).
Between 1924 and 1940, the num ber o f schools for non-W hite nurses and midwives increased from 5 to 17 and 3 to 5 respectively (2:65).By 1942, 106 Black nurses had passed the final general and 127 the final m idwifery exam inations (1:127); it is not recorded whether they were all ever regis tered, or still on the registers at that date.Some probably had dual registrations, so these figures may represent, perhaps, 200 persons.
The figures for Black hospital-certificated nurses, o f whom quite a num ber must have been trained and employed over the years, are not known.H ow ever, as against a total know n population at the 1936 census o f 6 595 597 Blacks** (4:A-5), the num ber o f Black nursing professionals available to render services to their own people was pitifully inade quate and the largest part of the burden, both o f service and of nursing education, was for many decades to com e to be carried by W hites, assisted in the service situation by non registered personnel.
By 1940 just after the outbreak of W orld W ar II, the position regarding nursing education and service for and by Black people was as follows: *In this paper the term non-W hite is used when it appears so in original sources or more accurate identification is not possible.

(b) Contents o f Curricula
Curricula have regularly (and in some cases at short intervals) been revised and updated, in order to prepare professional nurses for their extending role in our health services.Social, biological and natural sciences were introduced from 1953, and since 1969 there is increas ing em phasis on prom otive and preventive health care.

(c) Length o f training
The general course was reduced from 3,5 to 3 years, midwifery was increased from the original 6 and 12 months, first to 9 and 12 months (1949) and later to 12 and 24 months (1960).The courses for mental and mental defective nursing were reduced from (iii) Regulations for 3,5-year courses for registration as a general nurse and m idwife, and a general nurse and psychiatric nurse, were promulgated in 1969 and 1972 respectively, and for a 4-year course for gen eral, midwifery and psychiatric nursing in 1970 (only one W hite training school was ever registered for this course, and the Regulations have recently been w ith drawn).The 1975 amended Regulations for registra tion as a general nurse and midwife make provision for an optional course of 6 months for registration as a psychiatric nurse, and those for the general and psychiatric course for a similar course for registration as a midwife, on certain conditions which must be complied with during the 3,5 year courses.

Im plem entation o f Changes and Achievem ents
From the time of the Colonial Medical Councils till today, South African nurses of all races have written the same exam inations for registration.As regulations and syllabuses have been amended, or promulgated for new basic or post registration courses, W hite, Black, Coloured and Indian nurses have followed the same road towards registration or (since 1957) enrolm ent, w hether side by side or in single file .Control by a statutory body ensures that as hospitals are recognised as training schools, minimum standards as laid down in the Council's regulations for the particular course(s) for which they are recognised, are adhered to.There are two ways in w hich the success o f nursing educa tion program m es may be evaluated: (a) from exam ination results and the growth o f registrations and enrolm ents, and (b) from the contributions m ade by registered persons toward professional growth and developm ent in the preparation of future professionals, and in the health services o f their coun try.
Table IV reflects the results o f the final exam inations for the three basic professional categories.

Registration
The increase in the num ber o f registrations, since the beginning o f the century, is reflected in Table V, and an analysis o f the capacities in w hich these nurses were regis tered is set out in Table VI.To qualify for adm ission to a university, nurses are re quired to have a M atriculation exem ption, or in some cases at least an acceptable Senior Certificate (S t.X ).As the majority of nurses, until a few years ago, came into the basic courses wth only St. V III, it is small w onder that for many years so few presented them selves for the D iplom a in Nursing Educa tion courses, and that it took so long for degree courses to becom e established, or accepted by the profession.
G radually, at first painfully, by private or extra-m ural studies, nurses have attained St. X certificates.The introduc tion o f the basic course gave impetus to a growing realisation that higher academ ic qualifications for nurses were in future going to be a strong recom m endation, if not a requirem ent, for professional advancem ent.From the middle 1950's in creasing num bers of nurses registered for existing extra mural or teletuition degree courses, and since 1967 also for first started for Provincial Certificates, registrable with the Council.
The num ber and nature of these courses, dates o f first introduction, the extent to which Black nurses have availed them selves of post-registration training as courses have be come available, and the num ber of approved training schools for Black nurses as at the end of 1974 is reflected in Table VIII.

post-registration nursing degrees.
A large share of the credit for this " upward m obility" towards the highest academic qualifications must go to those nurse-leaders who in the 1950's, either in a personal or in an official capacity, by motivating, inspiring, cajoling and nag ging senior and junior nurses all over the country, and by lobbying influential persons as well as authorities, gave the impetus which by its ripple effect has set the profession on this exacting but rewarding course.
Apart from the basic nursing degrees, now offered at 9 universities, since 1967 post-graduate Honours, M asters' and D octorate courses are available.In 1968, a post registration degree course, the B. Cur.(I et A) was intro duced, enabling nurses who have not had the benefit of qualifying by a basic degree, to register for post-graduate studies, while at the same time registering an additional qualification in Nursing Education (I = " Instructionis" ) and Nursing Adm inistration (A = " A dm inistrationis" ) with the S. A . Nursing    But the battle is only half won.The ratio o f Black nurses to projected population as at 30 June 1974, was: nurses.The nursing service aspects of our health care sys tem s, which is a subject in itself, have only been cursorily m entioned.
There are gaps in our present knowledge which need to be filled in and updated.There is a whole field of research opportunities lying fallow.This is the challenge which now faces the graduate and post-graduate Black nurse in Southern Africa.
3,5 each to 3 years.(Exem ption from part o f each course, given to nurses registered in the alternate capacity, reduced the time for acquiring both registrations to 4 years.(d) New courses (i) In 1954 regulations were prom ulgated for a 3-year course for registration as a psychiatric nurse.The first students for this course, how ever, only registered in 1965 (3 (i)).In 1968 the D epartm ent of Health closed down their training schools for m ental and mental defective nursing (5(iii)).The first training school for Black nurses for the latter tw o qualifications com menced in 1956.(ii) Enrolled Auxiliary N urses.*In 1948 Provincial Regulations in the Transvaal, Cape Province and Natal for the training and exam ination o f Non-European N ursing A uxiliaries an d /o r A uxiliary M idwives, replaced the old hospital certification of this category.The Nursing Act o f 1957 (69/57) pro vided for their enrolm ent with the S.A .Nursing C ouncil, and C ouncil regulations for a 1,5-year course w ere prom ulgated in 1963.In 1970 the course was extended to 2 years.In 1972 regulations for a 6-m onth course for enrolment as an Assistant Nurse (required by Nursing A m endm ent Act No. 50 of 1972) were prom ulgated.
The degree to which the training o f Black nurses has increased is reflected in TablesI and II.*This designation was removed in 1972.

Figure 1 represents growth in registrations and enrolm ents up to 1977 FIG UR E 1 :
Figure 1 represents growth in registrations and enrolm ents up to 1977 FIG UR E 1: PR O G R ESSIO N , IN T H O U SA N D S, OF REG ISTR A TIO N AND EN R O LM EN T OF BLACK NURSES -1900 TO 1977 (started 1971): 65 have obtained the D iplom a in Nursing A dm inistration (started 1972): and 15 have obtained the degree B .C ur.(I et A).The first D iplom as in Nursing Adm inistration w ere, how ever, obtained by 19 students at the Kalafong College of N ursing, where a 2-year course for the C ouncil's regulations was started in 1971.Since then, the num ber o f Provincial schools for this course has increased to 3 (5:(v)).Two of the diplom ates o f the 1963-64 pilot course at the University College of the North, Mrs. M. Kau and Miss L.D. M akgopela, subsequently obtained an ordinary B. A. degree.In the 1971-73 academ ic years, Miss M akgopela studied for a M aster's Degree in Nursing at the University o f Connec ticut., U .S.A .TELETUITION FOR N URSING Q U A LIFICA TIO N S One of the most exciting and far-reaching events o f the present decade is undoubtedly the establishm ent, in 1975, of the D epartm ent o f N ursing at the U niversity o f South Africa.At the 1972 S. A. Nursing A ssociation Congress for White nurses in Port Elizabeth, the author had introduced a motion, which was carried with a large m ajority, requesting the Board o f the A ssociation to approach the U niversity o f South A frica regarding the institution of post-registration degree and diplom a courses for nurses.Only three years later, this goal was reached.The first students registered in 1976, and this year, 1978, the first H onours B .A .(C ur.) degree o f this University has been conferred on a Black nurse, M rs.Doreen Baartm an, who in 1976 was one o f the 5 first graduates o f the University o f the North.The importance and value o f the U nisa nursing courses may be judged from the num ber o f registrations as at 30 M o f South African nurses who, for dom es tic, geographical or other reasons, are unable to attend resi dential or extra-mural universities, the doors to nursing de grees and deplom as are now open, and the nurses are pouring in.PRO FESSIO N A L ADVANCEM ENT In 1933, a Black nurse was appointed to a Sister's post (8:12).In 1958, Miss Harriet Shezi becam e the first Black A ssistan t M a tro n , in a T ransvaal P rovincial H ospital (1:276).T oday, the majority of hospitals and sections of hospitals for Black people, as well as non-institutional health services, urban and rural, are staffed either entirely or almost entirely by Black registered and enrolled nurses.A num ber o f post-registration qualifications are held by Black nurses in top adm inistrative and teaching posts.The establishm ent o f independent H om elands and T er ritories and the re-organisation, from 1970, o f the H om e lands health services by the D epartm ent o f Health acting on behalf o f the D epartm ent o f Bantu A dm inistration and D e velopm ent (now D epartm ent o f Plural R elations)9, has given a trem endous im petus to opening up career oppor tunities for Black nurses.In the independent Territories, this is escalating.In 1977, 23 out o f 29 M atrons' posts in Transkei which were filled (2 were vacant) w ere held by Black nurses ( 10;21-2), a num ber o f w hom had a D iplom a in Nursing Adm inistration or in Nursing Education.O rganizers (or th e ir D e p u tie s/A ssista n ts) o f N u rsin g S erv ices in T ranskei, B ophuthatsw ana and in the majority o f H om elands are Black nurses.Black Sister Tutors and W ard Sisters have for a num ber o f years been successfully preparing candidated for the C ouncil's exam inations.A Black nurse holds a post as Lecturer at the University o f the N orth, and the first Black Sister Tutor in charge of a College o f Nursing in Lebowa was appointed in 1978.
(3:(ii))To date lack of facilities has prevented the institution o f a basic degree course for Black nurses.This must be regarded as top priority.C O N C LU SIO NIn a paper o f this nature, it is possible only to touch on a few aspects o f the history o f nursing education for BlackB IB L IO G R A P H Y .F .C .K .W ehr (1:107-8).
*In spite o f persistent efforts of nurse-leaders in the S.A .Trained N urses' A ssociation and members o f the Bantu N u rses' A ssociation (form ed 1932 (1:273) to prom ote facilities and opportunities for training Black professional nurses, progress was very slow.In 1928, the year when the M edical, Dental and Pharmacy Act (13/1928) brought nurs ing education and registration under the control o f the M edi cal Council, non-W hites were admitted to only 5 schools for nurses and 3 for midwives (2:65).

Medical and Dental Council the existing regulations for training general nurses, m idw ives, mental nurses and nurses for mental defectives. The m ost im portant changes which have been brought about since then are briefly the following: (a) Standard o f Education
**Figure probably not accurate -many Blacks not reached by census.

TABLE I
-* Includes the com bined 3,5 year and optional courses The effect, on recruitm ent of students for the general and psychiatric courses, o f the prescribing o f St. X as an admission requirem ent, is reflected in Table111.(Figurespriorto 1976are not to hand).
*Figure not to hand.**Includes 5 males *No students with more than St. X were registered.

TABLE V N
U M B ER O F BLACK N U RSES REG ISTERED IN YEARS EN D IN G 31 D ECEM BER (l:278:3(i)) Council.The D iplom a in Nursing Education course, started in 1936 at Cape Town University, has always been open to non-W hite students.The course started at the U niversity o f Natal 1956, was for many years offered to W hite and Black nurses in alternate years.By 1960, how ever, no Black Sister T u to r, was registered with the S .A .N ursing C ouncil.(1:279).The lim iting factor was, again, the standard of education.In 1961, a 2-year course for a Provincial T utor's D iplom a, registrable with the S.A .Nursing C ouncil, was given at the Baragwanath College o f Nursing.In 1963, the (then) U ni versity College o f the North, after negotiations with the T .P .A .andinaffiliation with the University o f Pretoria, accepted 9 carefully selected Black nurse students from Transvaal hospitals (only one o f whom had an acceptable St. X certificate.),for a 2-year pilot course, with one sem ester at the University and 18 months at the Kalafong College of Nursing.Seven students obtained the Diplom a.The U niver sity w as, how ever, not prepared to continue the experim ent until such tim e as applicants with at least an acceptable Senior C ertificate, and better facilities for presenting a course fulltim e at Turfloop, were available.This goal was reached in 1971, when the first Departm ent o f N ursing at a Black University was established at the (now) U niversity o f the North.To date 81 candidates have obtained the Diploma in Nursing Education in